Abstract
The association of obstructive uropathy and hydrops is rare but often fatal. Hydrops has been observed in our fetal lamb model with obstructive uropathy. We created a vesicoamniotic shunt 21 days after creating the obstruction to explore the effect of relieving the obstruction on the hydrops. Fetal lambs underwent urethral and urachal ligation at 60 days gestation. We created a vesicostomy (female) or urethrostomy (male) in 12 lambs to release the pressure 21 days after creating the obstruction. The fetuses were delivered at term (145 days), and the urinary tract was removed for histological examination. Six fetuses had severe hydrops at the time of the vesicostomy (group A), and six had no hydrops (group B). Only two lambs from group A survived (33%), and four lambs survived from group B (66%). Three lambs miscarried, and one was stillborn from group A. Two lambs from group B miscarried. In our fetal lamb model, hydrops appears to be associated with massive urinary ascites. We hypothesize that a connection exists between urinary ascites and hydrops. Vesicostomy, by bypassing the obstruction, may allow the lambs to recover from their hydrops. However, it is possible that by 21 days after creation of the obstruction, the damage created by the hydrops is irreversible.
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References
Kitagawa H, Pringle KC, Zuccollo J, Stone P, Nakada K, Kawaguchi F, Nakada M, Wakisaka M, Furuta S, Koike J, Seki Y (1999) The pathogenesis of dysplastic kidney in a urinary tract obstruction in the female fetal lamb. J Pediatr Surg 34:1678–1683
Pringle KC, Zuccollo J, Kitagawa H, Koike J, Delahunt B (2003) Renal dysplasia produced by obstructive uropathy in the fetal lamb. Pathology 35:518–521
Kitagawa H, Pringle K C, Koike J, Zuccollo J, Nakada K (2001) Different phenotypes of dysplastic kidney in obstructive uropathy in fetal lambs. J Pediatr Surg 36:1698–1703
Kitagawa H, Pringle K C, Zuccollo J, Koike J, Nakada K, Moriya H, Seki Y (2000) Early obstructive uropathy produces Potter’s syndrome in the lamb. J Pediatr Surg 35:1549–1553
Holzgreve W (1991) The fetus with nonimmune hydrops. In: Harrison MR, Golbus MS, Filly RA (eds) The unborn patient: prenatal diagnosis and treatment. WB Saunders, Philadelphia, pp 228–245
Kitagawa H, Pringle KC, Koike J, Zuccollo J, Seki Y, Fujiwaki S, Sato H, Nagae H, Nakada K (2003) Optimal timing of prenatal treatment of obstructive uropathy in the fetal lamb. J Pediatr Surg 38:1785–1789
Gest AL, Hansen TN, Moise AA, Hartley CJ (1990) Arterial tachycardia causes hydrops in fetal lambs. Am J Physiol 258:H1159–1163
Gest AL, Martin CG, Moise AA, Hansen TN (1990) Reversal of venous blood flow with atrial tachycardia and hydrops in fetal sheep. Pediatr Res 28:223–226
Rice HE, Estes JM, Hendrick MH, Bealer JF, Harrison MR, Adzick NS (1994) Congenital cystic adenomatoid malformation: a sheep model of fetal hydrops. J Pediatr Surg 29:692–696
Chao AS, Chung CL, Chung CL, Lien R, Soong YK (1998) Thoracoamniotic shunting for treatment of fetal bilateral hydrothorax with hydrops. J Formos Med Assoc 97:646–648
Salomon LJ, Audibert F, Dommergues M, Vial M, Frydman R (2003) Fetal thoracoamniotic shunting as the only treatment for pulmonary sequestration with hydrops: favorable long-term outcome without postnatal surgery. Ultrasound Obstet Gynecol 21:299–301
Grebille A, Mitanchez D, Benachi A, Aubry MC, Houfflin-Debarge V, Vouhe P, Dumez Y, Dommergues M (2003) Pericardial teratoma complicated by hydrops: successful fetal therapy by thoracoamniotic shunting. Prenat Diagn 23:735–739
Faber JJ, Anderson DF (1994) Hydrops fetalis in nephrectomized fetal lambs infused with angiotensin 1. Am J Physiol 267:R1522–1527
Weissmann-Brenner A, Ferber A, O’Reilly-Green C, Avila C, Grassi A, Divon MY (2004) Inferior vena cava thrombosis presenting as non-immune hydrops in the fetus of a woman with diabetes. Ultrasound Obstet Gynecol 23:194–197
Soper RT, Pringle KC, Scofield JC (1984) Creation and repair of diaphragmatic hernia in the fetal lamb: techniques and survival. J Pediatr Surg 19:33–40
Pringle KC, Turner JW, Scofield JC, Soper RT (1984) Creation and repair of diaphragmatic hernia in the fetal lamb: lung development and morphology. J Pediatr Surg 19:131–140
Scagliotti D, Shimokochi DD, Pringle KC (1987) Permanent cardiac pacemaker implant in the fetal lamb. Pacing Clin Electrophysiol 10:1253–1261
O’Connell AE, Boyce AC, Lumbers ER, Gibson KJ (2003) The effects of asphyxia on renal function in fetal sheep at midgestation. J Physiol 552:933–943
Golbus MS, Harrison MR, Filly RA, Gallen PW, Katz M (1982) In utero treatment of urinary tract obstruction. Am J Obstet Gynecol 142:383–388
Acknowledgements
This study was supported by the Japanese Society for the Promotion of Science (JSPS), Grant-in-Aid for Scientific Research (C). Suture materials (Biosyn) were supplied by Tyco Healthcare, Japan.
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Kitagawa, H., Pringle, K.C., Koike, J. et al. Fetal hydrops in experimental obstructive uropathy resolves after vesicostomy formation: is this cause and effect?. Ped Surgery Int 21, 25–28 (2005). https://doi.org/10.1007/s00383-004-1257-9
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DOI: https://doi.org/10.1007/s00383-004-1257-9